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Preference: Administration and Health Services

2

Patients, doctors forced to mind the gap as rebate freeze bites

Many private health funds are refusing to index their benefits while Federal Government persists with its Medicare rebate freeze, adding to the financial pressure on medical practitioners and their patients.

While health insurer HCF has launched a “known gap” scheme, in addition to its existing “no gap” schedule, to help offset the effects of the ongoing Medicare rebate freeze, other funds are holding steady, fuelling fears increasingly inadequate benefit payments will force doctors to either close down or raise patient out-of-pocket costs.

In a statement released to mark the third year since Medicare rebates for specialist consultations and operations were last indexed, and the passing of the first year of a projected four-year freeze on GP rebates, AMA President Professor Brian Owler warned that the Government’s policy threatened the viability of many practices.

Professor Owler said the Government was using the rebate freeze, which will save it $1.3 billion over four years, to transfer the increasing cost of providing care onto doctors and their patients.

“The rebate indexation freeze is a co-payment by stealth,” he said. “While the rebates have remained unchanged, the costs of providing quality medical services continue to rise. This funding shortfall has to be met by patients and practices.”

While the Medicare rebate has been held flat, underlying inflation is growing at an annual rate of 2.35 per cent, wages are increasing by 2.3 per cent and the cost of hospital and medical services are rising by 6.5 per cent a year.

“Practice costs such as wages for practice staff, rent, electricity, technology, and insurance are increasing every year,” the AMA President said. “Medical practices cannot absorb these increasing costs for four years in a row and remain viable.”

Professor Owler said the Medicare rebate freeze was also having a significant effect on private health insurance, including forcing up premiums.

Some health funds have decided to index their benefits despite the freeze on Medicare rebates, but others have held theirs down unless or until the Commonwealth increases its payouts.

Health fund HCF has responded to the stand-off by introducing a known gap scheme to complement its existing no gap arrangement with many practitioners.

Doctors signing up to the known gap deal will receive a smaller benefit from HCF than those participating in the no gap scheme, but will have the option of charging HCF-insured patients and out-of-pocket expense.

The known gap arrangement came into effect on 1 July and HCF has asked providers to nominate either it or the no gap scheme. They cannot be part of both.

Adrian Rollins

 

 

 

Whistleblower doctors face jail threat from today

Controversial laws under which doctors could face two years imprisonment for speaking out about shortcomings in the health care of detained asylum seekers come into effect today.

In a measure critics complain targets whistleblowers and will further deepen the secrecy surrounding the operation of immigration detention centres, the new Australian Border Force 2015 Act legislation, passed by Parliament in May, demands that all detention centre staff – including health workers – take an oath, and threatens two years imprisonment for any unauthorised disclosure of information.

Introducing the legislation, Immigration Minister Peter Dutton told Parliament the measure was necessary to “provide assurance to industry and our domestic and international law enforcement and intelligence partners that sensitive information provided to the Australian order Force and my department…will be appropriately protected”.

But the new legislation has fuelled concerns about a lack of scrutiny and accountability in the operation of immigration detention centres, particularly given the disbandment of the independent Immigration Health Advisory Group in late 2013.

Calls by the AMA and other medical groups for an amendment to the law to protect health workers and allow them to advocate on behalf of their patients have so far fallen on deaf ears.

The Government has also ignored suggestions that responsibility for the administration of asylum seeker health services be transferred to the Health Department, and that a body to provide independent oversight of care be reinstated.

Doctors warn the legislation contravenes clinical independence, which is a fundamental tenet of medical practice, by seeking to make medical practitioners and other health workers subject to the demands of the Government.

Dr Ai-Lene Chan, Dr Peter Young and Dr David Isaacs said the new laws placed doctors working in detention centres in an increasingly invidious position.

“The restrictions placed on doctors working in immigration detention results in health care that cannot be consistent with Australian codes and clinical standards,” they said, noting that pathology test frequently go missing, IT communications are regularly disrupted and the supply of medicines is underdeveloped.

The doctors warned that the Australian Border Force 2015 Act would only serve to compromise care even further.

It said the restrictions it put in place would fundamentally compromise vital aspects practice like sharing clinical information and research, and engaging in professional discussion.

“The Australian Border Force Act directly challenges professional codes of ethical conduct, including the safeguard of clinical independence and professional integrity from demands of third parties and governments,” they wrote. “The legislation aims to silence health professionals and others who advocate for their patients.”

The focus on the treatment of detained asylum seekers is intensifying amid allegations that some detainees, including children, have been sexually assaulted and physically abused.

AMA President Professor Brian Olwer earlier this year highlighted an Australian Human Rights Commission report documenting disturbing cases of sexually and physical assault on children in detention.

Professor Owler said the findings underlined the need to get children out of detention.

“Detention is not a safe place for children and this report clearly defines that by the number of assaults, including sexual assaults, unfortunately, that have happened to children, but also the effects on children’s health, particularly mental health,” he said at the time.

Professor Owler said the issue demonstrated the need for greater transparency in the operation of detention centres, rather than deeper secrecy.

“One of the problems that we’ve got here is an issue of transparency. I think there are a lot of people, particularly doctors, that have been very concerned about the provision of health care.

“The standard of health care, particularly in offshore centres such as Nauru and Manus Island, is well below that we would expect on the mainland, and I think having some sort of independent health group as there used to be, indeed, to actually oversee that and provide some sort of transparency, that gives the Australian people the reassurance that we’re actually fulfilling at least the obligations of providing good health care to people that are in detention, is something that we really want to carry through.”

Adrian Rollins

Equity in vision in Australia is in sight

Implementing the roadmap to close the gap for vision — progress and more work to do

The roadmap to close the gap for vision was developed after extensive nationwide consultation and launched in 2012.1 It comprises 42 recommendations that span a whole-of-system approach to eliminate disparities in Indigenous eye health.2 These recommendations seek to increase accessibility and uptake of eye care services by Indigenous Australians; improve coordination between eye care providers, primary care and hospital services; improve awareness of eye health among patients and clinicians; and ensure culturally appropriate health services. The roadmap is a costed and sector-endorsed framework for a sustainable and efficient system. Community engagement is fundamental for achieving these objectives. It is essential that community and sector stakeholders drive and genuinely own this effort. This public health initiative includes activities to be implemented at regional, jurisdictional and national levels in order to achieve health system reform and improve patient engagement across the eye care pathway.

The roadmap aims at more than just improving eye health — it is about achieving equity. Up to 94% of vision loss in Indigenous adults is avoidable or amenable to treatment.2 Additionally, vision influences and is influenced by the social determinants of health. The child who can see the blackboard and the adult who can drive and participate in gainful employment have opportunities to improve their circumstances; social factors such as educational attainment and employment have a profound impact on a range of health outcomes. Vision also affects independence in activities of daily living, including self- and family care, and the ability to administer medication and manage other health issues. Finally, vision loss accounts for 11% of the health gap between Indigenous and non-Indigenous Australians,3 so it follows that fixing the eye care system to address avoidable vision loss will help to close the broader health and social gaps and will have flow-on effects well beyond eye health.

After decades of relative political inertia and a policy approach that has delivered periodic but short-lived activity,4 the roadmap has garnered considerable political and stakeholder support. Elements of the roadmap are currently being progressed nationally in several jurisdictions and in a number of health regions.

In this article, we report on the progress made in the 3 years since the launch of the roadmap, and call for support for these efforts from the broader medical and public health communities.

Regional activity

The roadmap identifies specific activities required at the regional level (Box 1). Regions take into account state or territory health department, Medicare Local and other boundaries, but should include a cataract surgical facility. Regional implementation requires the establishment of a collaborative network to coordinate and oversee regional activities. This group of key local stakeholders includes Aboriginal health services; the local hospital district; the Medicare Local; primary care; optometry and ophthalmology clinicians; and public health authorities. Regional implementation is iterative, requiring regular measurement of system performance and adoption of any necessary activity to bridge identified service delivery gaps.

To date, 12 regions have initiated this process (Box 2). They cover five jurisdictions and about 35% of Indigenous Australia. Regions are at different stages of implementation, and the factors influencing the assembly and composition of the collaborative networks have varied markedly, reflecting differences in local contextual factors and funding arrangements. A dedicated individual has been assigned to an eye health regional implementation role in some regions, either through specific additional funding or reassignment of existing staff resources. These individuals have often had a significant impact.

Regional implementation tools have been developed.5 These include an online calculator that provides first-order estimates of the expected burden of eye disease and associated need for eye care in a region; an eye care service directory template to be populated with local details; specification of regional data requirements for gap analysis and monitoring; and an implementation checklist to guide regional efforts.

The national program for trachoma control has had impressive results, with the prevalence in children reducing from 14% in 2009 to 4% in 2013.6

Expert technical advice and support spanning ophthalmology, optometry, health services management and public health are also available to regions through the Indigenous Eye Health Unit (IEHU) at the University of Melbourne. The IEHU maintains close communications with all regions and receives some federal Department of Health funding for this. The IEHU participates in national forums and regional collaborative network meetings as requested and facilitates the sharing of lessons learned and stakeholder networking between regions.

Jurisdictional and national activity

A number of roadmap recommendations have been fully implemented (Box 3) and we highlight some achievements and ongoing activities.

Governance

A national oversight function, reporting to high levels of government, is essential to govern the roadmap approach. The need for such national leadership and commitment to reducing disparities in Indigenous eye health has recently been noted in speeches in both the Senate and House of Representatives. A national oversight proposal has been presented to government and the appropriate ministerial/advisory forum to assume this function is currently being assessed.

Jurisdictional oversight varies across the country. In Victoria, an eye health committee sits within Koolin Balit, the Victorian Government strategic plan for Aboriginal health. Chaired by the state health department, this committee has broad membership including state and Commonwealth departmental authorities, clinicians and representatives of Indigenous health and eye health peak bodies. Elsewhere, such jurisdictional activity is less well developed, although a similar committee has been established recently in the Northern Territory, sitting within the Aboriginal health planning framework.

Eye health indicators and regular measurement of population eye health status

Regular monitoring of system performance is required at regional, jurisdictional and national levels, and parameters measured and reported need to be consistent across the country and over time. A series of indicators has been developed and recommended for periodic collection and collation at various levels of the health care system. These measures will ascertain the size of any service gaps, inform the nature of any action required to bridge disparities and measure impact over time.

Regular reporting on population-level eye health status is also required. After a 30-year deficit in national population-level eye health data, the National Indigenous Eye Health Survey was conducted in 2008 and its findings highlighted the gross inequities in the burden of avoidable visual impairment and blindness among Indigenous adults.7 National data are needed every 5 years to monitor progress and meet Australia’s international commitment to regularly monitor disease burden and reduce prevalence of avoidable blindness under World Health Assembly resolution 66.4.8 The Australian Government has recently committed funding for a National Eye Health Survey, to assess the eye health of both Indigenous and non-Indigenous Australians. This survey will update the data on vision loss, gauge the collective impact of roadmap activities and help inform future priority action areas.

Eliminating cost as a barrier to accessing eye care

To eliminate cost as a barrier to service uptake, the importance of cost-certainty and bulk-billing have been highlighted for clinicians.9 Approaches to health authorities have sought to reduce consulting fees charged above schedule and to ensure adequate public ophthalmology services.

Cost is also a potential barrier to accessing glasses. Criteria for nationally consistent subsidised spectacle schemes have been endorsed by eye care and Aboriginal peak bodies. Currently, availability, eligibility to access subsidies and out-of-pocket expense vary greatly between jurisdictions.10 Indigenous patients in Victoria can obtain subsidised spectacles at an out-of-pocket cost of $10. In other states, there is limited supply of free glasses under subsidy schemes. Advocacy continues for appropriate low-cost spectacle schemes in each jurisdiction.

Building eye health workforce capacity and coordination of care

Measures to increase workforce capacity, sustainability and resources include increased Commonwealth funding for visiting services, equipment and infrastructure; earmarked funding for ophthalmology training in outback services; and a Medicare item number for retinal photography to increase coverage of retinal screening for people with diabetes.

Recommendations for medical software packages include prompts for providers for annual eye examinations when an Indigenous patient with diabetes presents for care.

Commonwealth funds for visiting optometry and ophthalmology services will be allocated through jurisdictional fundholders from 2015. Significant efforts to improve funding arrangements, and for fundholders to improve the coordination of visiting services, will ensure the appropriate sequencing, frequency and mix of services.

Conclusion

Over the 3 years since the launch of the roadmap to close the gap for vision, progress has been made to increase services, improve efficiencies and support better Indigenous patient engagement with the eye care system. Demonstrable gains are being made and there is growing momentum around the roadmap initiatives, but much remains to be done, and increased government support is required. In partnership with Indigenous communities and organisations, the public health and medical communities have a responsibility to engage with this effort and help close the gap for vision. The template used for eye care has high relevance for integrating care between primary health and essentially all visiting specialist services. With concerted multisectoral effort, political will and a commitment to establishing a sustainable eye care system, the gross disparities in eye health that exist between Indigenous and non-Indigenous Australians can be eliminated. Equity in vision in Australia may well be in sight.

1 Roadmap to close the gap for vision: elements of regional implementation

2 Regional implementation of the roadmap, June 2015

3 Completed actions in implementing the roadmap, June 2015

Primary eye care as part of comprehensive primary health care

  • Online education resources developed in eye care, diabetic eye care and trachoma
  • Eye health training courses developed and delivered for Aboriginal health workers
  • Eye checks included in Medicare item 715 annual health assessments

Indigenous access to eye health services

  • Increased eye care delivered through Aboriginal Medical Services
  • Cultural training incorporated in funded outreach eye programs
  • Sector agreement on subsidised spectacle supply

Coordination and case management

  • Project officers assigned in some regions
  • Service directories developed in some regions

Eye health workforce

  • Increased linkage between optometry and ophthalmology outreach programs

Elimination of trachoma

  • New national guidelines released
  • National surveillance and reporting continued

Monitoring and evaluation

  • Gap and needs analysis for service requirements undertaken in some regions
  • National Eye Health Survey partially funded
  • Eye health included in the National Health Performance Framework
  • Annual roadmap progress reports released

Governance

  • Eye care and Aboriginal health sector support for the roadmap

Stakeholder networks established in some regions

  • Indigenous eye committees established in some jurisdictions

Health promotion and awareness

  • Trachoma health promotion continued
  • Eye care health promotion material for patients with diabetes being developed

Health financing

  • Trachoma surveillance and treatment funded to 2017
  • Roadmap cost estimates revised

Mental health experts given tight reform deadline

A group of mental health experts has been given just four months to develop a detailed plan for the Federal Government to implement far-reaching changes to the nation’s disjointed mental health system.

A 13-member Expert Reference Group led by former Liberal ACT Chief Minister and beyondblue Chair Kate Carnell held its first meeting today, 18 June, and has been given until October to finalise an action plan to implement a number of changes recommended by the National Mental Health Commission in its searing review of the system.

The tight timeline has been praised by Commission Chair Professor Alan Fels, who said the review he led had provided a practical plan for modernising and reforming the mental health system and it was vital that the process of reform get underway.

 

“It’s important that implementation of the review’s recommendations and actions commences as soon as possible, because the review lays out what is a long term plan for reforms,” Professor Fels said. 

The review found the mental health system was poorly planned and badly integrated, and urged an increased focus on prevention and early intervention.

Controversially, it called for at least $1 billion to be redirected from public hospitals to fund community-based mental health services – an idea immediately dismissed by Health Minister Sussan Ley.

But Ms Ley said the review showed there were clear failures in current arrangements and the Government was committed to “meaningful long-term reform”.

The Minister said advice from the Expert Reference Group would help inform discussions she will have with State and Territory governments about developing a new National Mental Health Plan with much-improved co-ordination between federal, state and local bureaucracies and services.

“We have a real opportunity to deliver meaningful long-term reform through this Mental Health Commission Review, and this Government is committed to action,” Ms Ley said. “However, it’s clear…there are still implementation issues to be ironed out. That’s why this Expert Reference Group is so important, to ensure the mental health sector and Government work together closely to ensure recommendations can be practically implemented as we finalise our action plan over the next few months.”

Mental health groups have welcomed the formation of the Expert Reference Group, but its tight time frame has some concerned.

Mental Health Australia Chief Executive Frank Quinlan told The Australian the group would be under “considerable pressure”, and warned that, with so many programs scheduled to end by early next year or be subsumed into the National Disability Insurance Scheme, it was essential the advisory group laid out a properly costed plan to provide the high quality services and programs.

But beyondblue Chair Jeff Kennett welcomed the Government’s urgency.

“I am pleased that the Minister has asked the group to get on with the job quickly. We don’t need more drawn-out discussions about what is wrong with our mental health system. We already know it’s a complex, fragmented and hard-to-navigate system, and the people who suffer the most are the very people and families who need the most help,” Mr Kennett said.

“I hope as a result of the Expert Reference Group’s advice and Government’s quick response, some decisive and practical initiatives are identified and resolved, so people with depression, anxiety and at risk of suicide – and their families – get better outcomes.

“Let’s not just talk about preventing illness and ‘early intervention’, let’s make this a reality, so people don’t have to reach crisis point before they can access services.”

Adrian Rollins

Australia good, but can do better, on heart disease and stroke

Australia has one of the lowest mortality rates from cardiovascular disease in the developed world, but the nation has been told it needs to consider taxes on sugar-rich and unhealthy foods to combat rising obesity and diabetes.

Australia’s cardiovascular disease (CVD) mortality rate fell to 208 per 100,000 people in 2011, 30 per cent below the average among Organisation for Economic Co-operation and Development member countries of 299 per 100,000, and the potential years of life lost to circulatory diseases dipped to 372 per 100,000, 36 per cent below the OECD average of 581 per 100,000.

In a report released overnight, the OECD attributed the nation’s success in driving down deaths from heart attacks and stroke to accessible, high quality health care and effective public health policies, particularly in reducing smoking.

The Organisation said comprehensive tobacco control measures, including a hefty excise, mass media campaigns, advertising and smoking bans and, most recently, tobacco plain packaging laws, had helped drive the smoking rate down to 12.8 per cent last year, one of the lowest in the OECD and well below the average of 20.9 per cent among member countries in 2012.

But the OECD warned the nation needed to overcome several challenges if it was to cement and build upon its success in reducing CVD mortality.

It cautioned that Australia’s high obesity rate – 28.3 per cent, almost double the OECD average of 18 per cent – threatened to drive up the incidence of CVD unless it was addressed, and noted that the nation’s spending on preventive health measures had slipped to just 1.8 per cent of total health expenditure, well below the OECD average of 2.9 per cent.

In its first Budget, the Abbott Government abolished the Australian National Preventive Health Agency and absorbed its functions with the Health Department, heightening concerns of a loss of national focus and leadership on preventive health measures.

The OECD has also echoed warnings from the AMA about the dangers of deterring patients from seeing their doctor by imposing out-of-pocket costs.

AMA President Professor Brian Owler said the Government’s four-year freeze on Medicare rebates would create a patient co-payment “by stealth” by forcing doctors to reduce bulk billing and charge out-of-pocket (OOP) expenses.

The OECD said that Australian patients already faced higher than average out-of-pocket costs, and cautioned that “higher OOP costs will lead to a lower use of primary care services, particularly among the poor”.

Nonetheless, the Organisation said access to primary care in Australia was “generally good”, and the nation’s heavy use of cholesterol-lowering drugs – the highest in the OECD – showed there was ready access to medication.

The observation came two days after research was published estimating that 60,000 patients stopped taking cholesterol-lowering statins after the ABC television program Catalyst questioned their safety.

The OECD said Australians with CVD had access to good quality acute care. The 30-day case-fatality rate for acute myocardial infarction patients was 4.4 per cent, one of the lowest rates in the OECD, while case-fatality for stroke patients was around the OECD average and the proportion of stroke patients treated in dedicated facilities was higher than many other comparable countries.

The OECD said the country needed to curb the rise in obesity if it was to make further inroads into CVD fatality rates, and suggested it consider measures adopted in other countries, such as taxes on unhealthy or sugar-rich food and drinks and the development of nationally-co-ordinated health promotion programs.

Adrian Rollins

 

 

Keep GP costs down to win fight against rich world’s biggest killer, OECD says

Decades of success in cutting deaths from heart attacks and strokes are at risk unless governments ensure patients have affordable access to primary health care, the Organisation for Economic Co-operation and Development has warned, adding to pressure on the Federal Government to dump its controversial freeze on Medicare rebates.

As the AMA intensifies its campaign against the four-year freeze, which is set to drive down GP bulk billing rates and force up patient out-of-pocket costs, the OECD has said that affordable and accessible primary care is essential if the world is to build upon a 60 per cent decline in the cardiovascular disease mortality rate in the past 50 years.

In a major report on cardiovascular disease and diabetes released overnight, the OECD said although massive strides had been taken in reducing deaths from cardiovascular disease (CVD), it still remained the most common cause of death in developed countries, and rising rates of obesity and diabetes threatened to slow or even reverse these gains without a greater focus on preventive health, accessible quality primary care and more effective hospital systems.

“The prospects for reducing the CVD disease burden are diminishing, and the pattern of declining mortality is coming to an end or even reversing amongst some population groups, particularly younger age groups,” the Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care report said. “Rising levels of obesity and diabetes are reducing our ability to make further inroads into reducing the CVD burden.”

The OECD warned that, on current trends, almost 108 million adults across the OECD would have diabetes by 2030, while an extra 23 million would have greater health needs and a higher risk of complications.

The report paid much of the credit for the decline deaths from heart attacks and strokes in recent decades to public health campaigns, particularly on smoking.

All OECD countries have taken anti-tobacco measures including mass media campaigns, higher taxes, advertising bans and quit services, with the result that between 1997 and 2009 the proportion of adults lighting up daily fell from 28 to 20 per cent.

“Smoking policies have been shown to be highly effective. Tobacco control policies…have saved lives,” the OECD said.

It said that although evidence about the effectiveness of Australia’s world-leading tobacco plain packaging laws was still being gathered, the initiative “may provide the next set of policy instruments for governments to help further reduce the harmful impact of smoking”.

But governments have so far been much less successful in curbing rates of obesity and diabetes, which the OECD said would instead revolve around the strength of a country’s primary health care system.

“Primary care is the centre of the health care system, and is particularly so for CVD and diabetes,” it said, emphasising the importance of affordable and accessible quality care.

“A highly accessible primary care system has the capacity to reduce inequalities in health outcomes and deliver care to those who stand to benefit most,” the report said. “This is particularly important for diseases such as diabetes, which is far more prevalent among lower socio-economic groups.”

It is a timely warning as the AMA ramps up its campaign against the Federal Government’s plan to freeze Medicare rebates until mid-2018.

AMA President Professor Brian Owler has criticised the policy as a “co-payment by stealth” because rising practice costs will force many GPs to dump bulk billing and charge their patients out-of-pocket fees.

Professor Owler said this was concerning because it raised the risk that patients would put off seeing their GP until their health problem became so serious it required hospitalisation.

It is a concern shared by the OECD, which warned that how primary care was funded had “enormous implications” for access to care and health.

“Higher out-of-pocket costs will lead to a lower use of primary care services, particularly among the poor,” it said. “By foregoing routine visits…patients are exposed to greater risk leading to a worsening of health status.

“It is therefore essential that primary care remains highly accessible to all.

“Good access is a necessary requirement to enable primary care practitioners to have regular contacts with patients, assess patient risk, monitor progress, deliver care and adjust treatments when required.”

As part of its report, the OECD examined ways to improve the quality of primary and acute care, including using digital technology to share up-to-date patient information and monitoring their health, as well as pay-for-performance schemes, better hospital access and public reports on the relative performance of hospitals and other health services.

It found that although there was some evidence that pay-for-performance schemes, under which doctors are paid for outcomes – usually in chronic and preventive care – can achieve some improvements, this is often highly contingent on a range of other conditions being in place, meaning great care had to be exercised in implementing such a payment model.

While lauding the success of recent decades in curbing CVD mortality rates, the OECD nonetheless said that it remained the “number one killer” in most member countries, and there were concerns about riding rates of obesity and diabetes, and gaps between recommended health care and that which was actually provided.

The Organisation said it was not just a matter of more money.

“The evidence on what constitutes good quality care has been I the public domain for decades, but many OECD countries are still coming to terms with the changes that need to be made in their health systems to deliver such care,” it said.

The OECD said that one of the most significant challenges was to take evidence about best treatment and make it part of everyday practice.

Adrian Rollins

 

 

Curb the drinks to cut the violence

Australian of the Year Rosie Batty has backed calls for a crackdown on sales of alcohol, including an end to 24-hour trading and a buyback of liquor licenses, as part of efforts to stamp out family violence.

Echoing the AMA’s call last year for governments nationwide to take strong action to curb alcohol-related violence, Ms Batty has urged national leaders including Prime Minister Tony Abbott and Opposition leader Bill Shorten to adopt a set of proposals developed by the Foundation for Alcohol Research and Education (FARE) to reduce the saturation of alcohol in the community.

“There is not, and can never be, an acceptable level of family violence,” Ms Batty said. “Prevention must be our ultimate goal, and we must do everything in our power to stop it.”

Ms Batty’s plea has underlined the outcomes of the National Alcohol Summit organised by the AMA last October that called for a consistent national approach to the supply and availability of alcohol, including statutory regulation of alcohol marketing and a review of taxation and pricing arrangements.

AMA President Professor Brian Owler, who convened and led the Summit, said at the time that alcohol misuse was one of the country’s major health issues, with estimates that the damage it caused through violence, traffic accidents, domestic assaults, poor health, absenteeism and premature death, cost the community up to $36 billion a year.

“Alcohol-related harm pervades society. It is a problem that deserves a nationally consistent response and strategy,” Professor Owler said.

In recognition of the fact that often family doctors are the first port of call for victims of domestic violence, the AMA, in conjunction with the Law Council of Australia, last month released a toolkit providing guidance and resources for GPs in helping patients who have been attacked by their partners.

The Supporting parents experiencing family violence – a resource for medical practitioners toolkit can be downloaded at:  article/ama-family-violence-resource

The plan to prevent alcohol-related family violence developed by FARE, launched by Ms Batty on 17 June, calls for those applying for liquor licenses to be subject to more stringent approval process, a restriction on trading hours, a liquor licensing freeze or buybacks in saturated areas, an end to 24 hour licences and an extra levy on alcohol to help pay for the costs incurred by governments in responding to family violence.

FARE said alcohol was a factor in 65 per cent of family violence incidents reported to police and almost half of child abuse cases. In addition, more than a third of those who murdered their partner had been drinking prior to the attack.

Chief Executive Michael Thorn said a tough problem called for tough solutions.

“Alcohol’s involvement in family violence is undeniable,” Mr Thorn said. “Governments must acknowledge the vast research and the irrefutable evidence that clearly links the availability of alcohol with family violence, and act accordingly. In practice, that means putting public interests ahead of the alcohol industry and being prepared to say no to liquor licence applications that put people at greater risk of harm.”

The FARE plan echoes the recommendations of last year’s AMA Summit in emphasising measures aimed at preventing alcohol-related harm while simultaneously urging ongoing funding for vital alcohol support and treatment services.

Professor Owler said that although individuals and communities had a role to play, governments – particularly the Commonwealth – needed to be far more active in tackling the issue.

“Too many times we hear that it’s all about personal responsibility. It’s rubbish,” Professor Owler said. “Personal responsibility is important, but we can’t rely on the personal choices of others for our own safety and health. Governments can influence behaviour through deterrents but, most importantly and more effectively, through shaping individual and societal attitudes to alcohol.”

For more information on the AMA National Alcohol Summit, visit: ausmed/end-cheap-grog-and-saturation-marketing-alcohol-summit-tells-govt

The National Alcohol Summit communique can be viewed at: media/ama-national-alcohol-summit-communique

Adrian Rollins

 

Disability support services: services provided under the National Disability Agreement 2013–14

In 2013–14, an estimated 321,531 people used disability support services under the National Disability Agreement (NDA), including 4,200 who transitioned to the National Disability Insurance Scheme (NDIS) during the year. Over half (55%) of all NDA service users had an intellectual or learning disability and many needed at least some assistance in one or more of the three broad life areas—activities of daily living (68%), activities of independent living (82%), and activities of work, education and community living (86%).

No crisis, but change is needed: Ley

Health system funding is not in crisis but there needs to be an overhaul of the way the Federal Government pays for GP and hospital services, Health Minister Sussan Ley told the AMA National Conference.

Setting out markers for the future direction of Government health policy, Ms Ley put doctors and state governments on notice that there will be changes to how the Commonwealth funds health care.

But, in a marked change of tone from her predecessor Peter Dutton, the Minister dropped warnings that health spending was unaffordable and embraced a collaborative approach to change.

“The Government is not claiming that we are in a health funding crisis,” Ms Ley said, though she added that, “we are saying that we have to be realistic. If we don’t make changes now, we will face a funding crisis.”

While the Government has dumped the idea of a GP co-payment, Ms Ley nevertheless said the current fee-for-service model of GP remuneration had to change.

“We need to shift from a fragmented system based on individual transactions, to a more integrated system that considers the whole of a person’s health care needs,” she said. “Innovative and blended funding models will be needed to provide appropriate care for patients with complex, ongoing conditions.”

In a warning for adherents of the current fee-for-service model, this is one area of health policy where there appears to be bipartisanship.

In her speech to the AMA Conference, Shadow Health Minister Catherine King said that, “I don’t for a moment suggest we abandon fee-for-service,” but warned there needed to be a “serious conversation” about whether it was best serving patients and rewarding good care.

Ms King said there were hundreds examples across the country of practices providing innovative and preventive care, often involving multidisciplinary teams led by GPs, but “the system as it works at the moment…does not provide incentives to reward this sort of activity. Nor does it reward outcomes”.

The issue of GP funding was the focus of a separate policy session at the Conference (see Providing high quality care doesn’t pay, px), where several presenters expressed concern of any change to funding arrangements that was not backed by sound evidence.

Among the speakers, AMA Victoria President Dr Tony Bartone said there was as yet no substantiated claim that alternative funding arrangements would deliver better patient outcomes than the fee-for-service model.

But Ms Ley said part of the change was aimed at ensuring better care for patient with complex and chronic conditions, as well as those with mental health problems.

She added that the Primary Health Networks being set up to replace Medicare Locals would be funded to “commission health and medical services to fill gaps”.

The Commonwealth has been heavily criticised for last year’s decision to axe the popular Prevocational General Practice Placements Program and abolish General Practice Education and Training, but at the Conference Ms Ley announced that competitive tenders for general practice training had opened. Successful bidders will receive funding to administer the Australian General Practice Training program, including co-ordinating and overseeing placements for GP registrars.

Tenders close on 10 July, and successful bidders will be funded from 1 October this year to the end of 2018.

 

Adrian Rollins